title: Dramatic changes of the gut flora immediately after severe and sudden insults.
abstract: BACKGROUND
  The gut flora is crucially involved in host homeostasis. However, the changes in the gut flora during the early phase of a critical illness are unknown.
  
  
  OBJECTIVE
  We investigated the changes in the gut flora at an early phase of severe insult in critically ill patients.
  
  
  METHODS
  Fifteen patients who experienced a sudden and severe insult were studied, along with 12 healthy volunteers as the control group. Fecal samples were acquired from the subjects by swabs of the rectum within 6 h after admission to the emergency room (day 0). Samples were serially collected from patients until day 14. Samples were also collected from control subjects.
  
  
  RESULTS
  On day 0, total bacterial counts were decreased to one-thousandth the number of the control subjects, in particular, obligate anaerobes and Lactobacillus were significantly decreased. In addition, on day 0, the major short-chain fatty acids of the patients were significantly lower than those of the control subjects. The gut flora and the concentrations of major short-chain fatty acids did not recover to normal levels. In contrast, Enterococcus and Pseudomonas increased during the study period.
  
  
  CONCLUSIONS
  The gut flora in critically ill patients changed immediately after a severe insult. The concentrations of the three major short-chain fatty acids were immediately decreased in tandem with the destruction of the gut flora. The gut flora and the concentration of major short-chain fatty acids did not improve during the first 2 weeks after hospital admission. At the same time, the number of harmful bacteria gradually increased.
authors.affiliation: Emergency and Critical Care Center, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan. mineji@dream.com
authors.forename: Mineji
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Asahara
authors.forename: Naomi
authors.initials: N
authors.lastname: Henzan
authors.forename: Hiromoto
authors.initials: H
authors.lastname: Murakami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Mukai
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Minami
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sugano
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Kubota
authors.forename: Shinji
authors.initials: S
authors.lastname: Uegaki
authors.forename: Hisako
authors.initials: H
authors.lastname: Kamoshida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sawamura
authors.forename: Koji
authors.initials: K
authors.lastname: Nomoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gando
mesh_terms: D000328:Adult; D058491:Bacterial Load; D016638:Critical Illness; D016983:Enterococcus / Q000302:isolation & purification; D005232:Fatty Acids, Volatile / Q000378:metabolism; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D007778:Lactobacillus / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D011549:Pseudomonas / Q000302:isolation & purification
chemical_list: D005232:Fatty Acids, Volatile